Your Gender Identity*
Best email for communication about this event*
Your Job Title
Industry/Profession or Job Description*
Internship Day Date*
I can participate in Internship Day on the following days:
Wednesday, October 17
Friday, October 19
Available either day, but only one or the other
Can take students BOTH days, if needed
Please write in block form. This is where students will send a thank you note.
Is mailing address the same as location for Internship Day?*
Location for Internship Day
This should also be the number for emergency contact on Internship Day. Please leave two numbers if you feel it would be appropriate.
Does your company have a website or other websites you can recommend for students to view prior to coming to work?
Number of Students You'd Like to Mentor*
We recommend no more than 4 students for any one site.
Two (or less)
Three (or less)
Four (or less)
Picking Up Students*
Yes, I am able to pick up my student(s) at Catherine Cook between 8:00-8:30 a.m. (preferred)
No, I need to suggest an alternate time for pick-up at Catherine Cook.
No, please have student(s) meet me at my work place.
Describe in detail the preferred time or place for students to meet up with you in the morning.
Can you provide lunch for student(s)?
I will provide lunch.
Student(s) should bring their own lunch.
I will be bringing student(s) back to school before lunch time (1:00 p.m.).
Dropping off Students*
Yes, I am able to drop off student(s) at Catherine Cook between 1:00-2:00 p.m. after lunch. (preferred)
No, I need to drop off student(s) at Catherine Cook at an earlier time.
No, please assist me in getting student(s) back to school.
Describe in detail the preferred drop-off time or how we can try to assist bringing students back to school.
Are you a Catherine Cook Parent?*
In what grade(s)?
Any additional comments?
Please send a confirmation email to the address below*:
Please provide an email address where we can send a link to your current form.
Email Address :